Action Points

Explain to interested patients that exercises done at home are often part of physical therapy to increase the "dose" of treatment.

Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

SAN FRANCISCO, July 13 -- For those who suffer tennis elbow, wrist-strengthening exercises with an inexpensive rubber bar may relieve pain and restore function, a small trial revealed.

Adding these exercises to home care dramatically increased the number of patients with reduced disability scores, compared with standard care alone (76% versus 12%, P=0.01), Timothy F. Tyler, PT, ATC, of the Nicholas Institute of Sports Medicine and Athletic Trauma in New York, and colleagues found.

Pain and tenderness likewise improved at least fourfold more with the addition of isolated eccentric wrist extensor strengthening, they reported at the annual meeting of the American Orthopaedic Society for Sports Medicine in Keystone, Colo.

This kind of exercise has been shown to be effective for tendon-related Achilles, shoulder, and knee pain in the past, but there was no easy way to provide resistance while the elbow made this motion, the researchers said.

A simple rehabilitation routine is likely to be welcome on and off the tennis court. An estimated one to three percent of the population develop tennis elbow, and only a fraction of them actually play the game.

"Up until now, the only way to do isolated eccentrics for the tennis elbow was on a big, $50,000 isokinetic machine that would be in someone's office," Tyler said.

His group had been searching for a way to make the therapy work in the home when they happened across a solid rubber bar -- similar to the baton passed by relay runners but flexible enough to be twisted.

To test it, they enrolled a group of 21 patients who had reported chronic symptoms of lateral epicondylitis -- a.k.a. tennis elbow -- for at least six weeks, but had no prior surgical treatment for it.

For the investigational exercise, patients were given a Thera-Band FlexBar to twist with the wrist of their uninjured arm and then slowly untwist with eccentric wrist extension of the injured arm over a period of about four seconds. Three sets of 15 repetitions were scheduled each day.

After seven weeks of physical therapy in both groups, pain scores improved to an average of about 5 on the 10-point Visual Analog Scale in the standard treatment group -- but dropped all the way to about 1 point in the isolated eccentric exercise group.

The mean improvement in pain was 81% in the group that used the bar compared with 22% in the control group (P=0.002 for difference in improvement over time by group and P<0.0001 for post-treatment score by group).

Tenderness in the affected elbow also decreased in the experimental group, though not in the standard group (P=0.003 between groups).

Although the standard treatment produced a small decline in deficits, 28% to 26% (P=0.79), the difference between groups missed statistical significance (P=0.058).

When combined with improvement in middle finger extension strength, improvement in the combined strength deficits was superior with the investigational exercise compared with standard treatment (P=0.032).

The researchers cautioned that their study was limited by the small sample size, but noted that the treatment for home use was practical, inexpensive, did not require direct medical supervision, and had no significant side effects.

Among the wide array of treatments for tennis elbow -- ranging from strengthening and stretching to cortisone injections and extracorporeal shockwave therapy -- all have been shown to be, at best, equivocal in efficacy, Taylor said.

He said that the "maximal" efficacy of the new treatment would thus likely compare favorably against anything else available and could lower healthcare costs.

The Hygenic Corporation donated the Thera-Band FlexBars used in the study.

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